New Tracking of a Patient's Radiation Exposure

During a four-week hospital stay, 29-year-old Josh Page had so many CT scans that he lost track, kidding with his doctor about how much radiation he was exposed to—though he admits he had "no clue."

ENLARGE

Josh Page of Clearfield, Utah, can access information about radiation levels from scans he underwent during hospital treatment last winter. Right, his son Kayden.
Brandie Page

Now, Intermountain Healthcare, where he was treated for an inflammation of the pancreas and underwent surgery in February, is keeping track for him.

In an unusual approach to reduce medical-radiation exposure, Intermountain Health Care of Utah will announce a program to track patients' cumulative radiation exposure and use it to help guide treatment decisions. Laura Landro reports on Lunch Break. Photo: AP.

The Salt Lake City-based nonprofit group of 22 hospitals and 185 clinics is launching the first major system of its kind to measure and report patients' cumulative medical radiation exposure from tests that deliver the highest amount of radiation. This includes CT scans, nuclear medicine scans and interventional radiology exams for the heart. In addition to educating doctors and patients about the risks and benefits of medical radiation, Intermountain will allow them to access their exposure data via its electronic health record.

While the benefits of tests and procedures usually outweigh the slightly increased cancer risk from exposure due to radiation, "the risks should be considered before these imaging tests are performed," says Keith White, medical director of Intermountain's Imaging Services. This is particularly true for younger patients, who have a higher risk because they live long enough to see long-term effects.

ENLARGE

The hope is that the data from about 220,000 annual CT scans and radiology procedures each year on Intermountain Health's patients will make it easier to determine care. For example, a CT might be skipped if equivalent information can be obtained with a test that doesn't use radiation, such as an MRI or ultrasound. Also, lower doses of radiation can be used in certain heart procedures, Dr. White says.

The idea of hospitals collecting and reporting radiation doses for individual patients is controversial. There is no definitive answer on how much medical radiation is too much, and some scientists argue that the body naturally repairs or replaces radiation-damaged cells.

Federal data shows that in 2006, Americans received seven times more radiation exposure than in the 1980s, with much of the increase coming from CT scans and tests that use small amounts of radioactive material to diagnose and assess coronary artery disease. Since 2006, growth in use of CT scans has slowed amid a push for doctors to order fewer tests, both to reduce costs and protect patients from unnecessary radiation exposure. Concern over the potential cancer risks has already led to widespread changes.

Radiology groups, researchers and equipment suppliers are working to lower radiation exposure through improved software programs, and new machines that deliver reduced doses. The National Institutes of Health is incorporating radiation-dose exposure reports into electronic medical records at its own clinical center.

More on Minimizing Imaging Risks

Nashville, Tenn.-based Hospital Corporation of America,HCA0.05% the largest for profit hospital system, is planning to track patient doses as part of a new Radiation Right campaign. The American College of Radiology is sponsoring a national Dose Index Registry to allow providers to compare their CT doses against national benchmarks, and is a lead sponsor of Image Wisely, a safety campaign.

Radiation doses are measured in units known as millisieverts, or mSv. Atomic bomb survivor data shows a significant association between developing cancer and a radiation exposure about 100 mSv. But it isn't clear whether the risk is the same from cumulative exposure in smaller doses, such as multiple CT scans each delivering 10 mSvs. The overall risk of getting cancer in anyone's lifetime is 40% and some experts feel that 100 mSv of medical radiation can increase this by 1%.

For most medical tests, the added cancer risk is so small it can only be measured on a population rather than an individual basis. And even exposure data isn't a reliable measure because it can vary highly by such factors as age, gender, the body part exposed to radiation and the patient's size, says James A. Brink, chief radiologist at Massachusetts General Hospital and co-chairman of Image Wisely.

Richard Morin, a Mayo Clinic radiology expert who chairs the Dose Index Registry, says knowing the number in mSv of radiation exposure "is of no great benefit to patients." What is important, he says, is whether the amount of radiation a patient is receiving is "optimal" to determine if there is a medical problem.

"Patients should be asking doctors, 'Why are you doing this test and what do you hope to find out with it that you didn't know from the last test?' " Dr. Morin says.

Mr. Page, a maintenance technician who lives in Clearfield, Utah, learned that his cumulative exposure from multiple scans he received at Intermountain was 97.3 mSv. The father of three admits it was "scary" to read a pamphlet telling him the radiation exposure from each scan, but he was comfortable with the idea that the scans were necessary to monitor cysts associated with his pancreatitis. "I am aware of the risk but the fact is I'd rather make it to the point where I might see long-term effects than have a problem now and not get to that point," he says. "But it is good to know the information is there for the future," he says.

Recent studies by researchers at Massachusetts General make the case that the risks of death from a current medical condition often far outweigh the risk of radiation. For example, a study in the journal Radiology in March found that for young men with testicular cancer, the mortality risk from their cancer was three times higher than from radiation-induced cancer.

A survey of physicians to be published this week in the American Journal of Roentgenology found doctors were uncertain about how to factor in a patient's past radiation exposure when considering a new imaging test, according to lead author Pari Pandharipande, a senior scientist at Massachusetts General's Institute for Technology Assessment.

"Patients have a right to all the information that concerns their medical history, but physicians need to be better equipped to understand what to do with that information," says Dr. Pandharipande.

Another study from the May issue of Radiology found that among patients ages 18 to 35 undergoing chest CTs and abdominal CTs for cancer, trauma and abdominal pain, the short-term risk of dying from an underlying condition was 7.1% and 3.9%, respectively, compared with long-term risk from radiation-induced cancer of 0.1%. "There is a lot of talk about unnecessary imaging, but even if a test is negative it doesn't mean it was unnecessary," says lead investigator Susanna Lee, a Massachusetts General radiologist.

This copy is for your personal, non-commercial use only. Distribution and use of this material are governed by our Subscriber Agreement and by copyright law. For non-personal use or to order multiple copies, please contact Dow Jones Reprints at 1-800-843-0008 or visit www.djreprints.com.